Endometrial Cancer Flashcards

1
Q

What are the high to high intermediate risk factors that would suggest a patient would benefit from vaginal brachytherapy?

A

Cervical stromal invasion, grade 2-3 endometrioid disease, LSVI, and myometrial invasion.

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2
Q

For Stage 1A w/grade 1-2 pathology, what is the adjuvant tx patients get after surgery? (endometrioid)

A

Per NCCN you can do observation (preferred). You can consider vaginal brachytherapy if there is LSVI and/or they are 60 or older.

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3
Q

For Stage IA disease (endometrioid) grade 3 disease what is the adjuvant tx after surgery?

A

Vaginal brachytherapy is preferred. You can consider observation if there is no myometrial invasion OR you can consider EBRT if LSVI or if 70 years or older (Cat2B)

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4
Q

What is the tx for Stage IB grade 1 disease after surgery?

A

Vaginal brachytherapy is preferred. Can consider observation if no LSVI and less than age 60.

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5
Q

What is the tx for Stage IB grade 2 disease after surgery (endometrioid)?

A

Vaginal brachytherapy is preferred. Consider EBRT if aged 60 or older and/or LSVI. Can consider observation for those less than age 60 and no LSVI.

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6
Q

What is tx for Stage IB and grade 3 disease after surgery (endometrioid type)?

A

EBRT and/or vaginal brachytherapy +/-chemo (Cat2B for chemo).

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7
Q

What is the tx of Stage II disease with Grade 1-3 pathology after surgery (endometrioid)?

A

EBRT (preferred) and/or vaginal brachytherapy +/- chemo (Cat2B rec for chemo).

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8
Q

What are the high risk histologic subtypes in endometrial cancers and how are they typically treated?

A

Serous, clear cell, carcinosarcoma, undifferentiated. They are treated with chemotherapy and usually a combination of EBRT and brachytherapy and surgery.

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9
Q

What is the management of Stage III/IV endometrioid Grade 1-3 disease?

A

After surgery they should receive systemic chemo +/-EBRT +/- vaginal brachytherapy

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10
Q

What is the tx for stage III/IV Uterine Serous Carcinoma and carcinosarcoma Her2+ disease?

A

Carboplatin/Paclitaxel/Trastuzumab. This was based off of a clinical trial that showed PFS improvement and OS benefit (in serous carcinoma), more so impactful in the upfront vs recurrent setting.

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11
Q

When is Carboplatin/Paclitaxel/Durvalumab indicated in advanced/metastatic disease?

A

This combo is approved for Stage III/IVA with measurable disease or for patients with Stage IVB w/ or w/o measurable disease as upfront therapy. dMMR is not required here.

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12
Q

When using Pembro/Lenvatininb in the second line setting, what is the survival data with this combo?

A

There is a significant improvement in PFS and OS. Only approved for recurrent setting after platinum combo.

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13
Q

What is the indication for Carboplatin/Paclitaxel/Dorstalimab in advanced/metastatic disease?

A

This is used for upfront therapy for IIIA, IIIB, IIIC1 w/measurable disease. Stage IIIC1-carcinosarcoma, serous, clear cell, mixed regardless of measurable dx. Stage IIIC2 or IV regardless of measurable dx.

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14
Q

When is hormone therapy indicated in metastatic disease?

A

You can use it for recurrent or metastatic disease, but only for those tumors with a low grade (e.g. grade 1/2) and very low tumor burden and endometrioid histology.

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15
Q

What is the preferred hormonal agent to use for endometrioid histology in the metastatic/recurrent setting? Other options?

A

Preferred-Megestrol Acetate alternating with Tamoxifen or Everolimus/ Letrozole. Others: Fulvestrant, Tamoxifen, AIs alone. Other progestins you can use also.

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16
Q

In ER+ endometrioid low grade tumors that are advanced/metastatic or recurrent what hormone combination can you use?

A

Letrozole/Ribociclib
Letrozole/Abemaciclib

17
Q

For those women who desire fertility preservation or are not suitable for surgery and have uterine limited disease only, what is the option used to treat?

A

Levonorgestrel IUD is the preferred option. Can also used Megestrol Acetate or Medroxyprogesterone Acetate.

18
Q

What is the tx for Stage IB-IV Carcinosarcoma? Stage IA?

A

Chemo (Carbo/Paclitaxel) +/- EBRT +/- Vaginal Brachytherapy. Stage IA-systemic therapy plus vaginal brachytherapy +/- EBRT

19
Q

What is the tx of Stage IA carcinosarcoma?

A

Chemo (Carbo/Paclitaxel) plus vaginal brachytherapy +/- EBRT

20
Q

When considering EBRT in carcinosarcoma, what pathology feature would make you more inclined to give this?

A

If both high grade epithelial components and sarcoma are dominant (>50% of sarcoma component in uterine tumor).

21
Q

What is the management of Stage I Leiomyosarcoma? In general how responsive is this tumor to chemo and RT?

A

Surgery followed by observation. In general they are not super responsive to chemo or RT and have a 50% recurrence rate when confined to the uterus.

22
Q

What is the tx for Stage II/III Leiomyosarcoma?

A

Consider observation if completely resected w/negative margins OR you can consider systemic chemo and/or EBRT

23
Q

What is the tx for Stage IVA and IVB Leiomyosarcoma?

A

For stage IVA you can do systemic chemo and/or EBRT. For Stage IVB you do chemo +/-palliative EBRT.

24
Q

Low grade endometrial stromal sarcomas can be treated with what therapy since they are low grade?

A

Hormonal therapy-AIs, Megestrol Acetate, medroxyprogesterone. Remember there are some tumors that can be high grade that need chemo like you would for Leiomyosarcoma.

25
Q

What chemo is used for Leiomyosarcoma?

A

Doxorubicin alone, Doxo w/darcarbazine ifosfamide, or trabectidin. Or you can consider Gemcitabine/Docetaxel.

26
Q

How is undifferentiated sarcomas of the uterus treated?

A

The same regimens used for leiomyosacoma. (e.g. doxorubin, docetaxel/gemcitabine, doxorubincin/ifosfamide, doxorubincin/dacarbazine).

27
Q

What is the first line tx for uterine leiomyocarcoma for stage III/IV disease? What is a second line option?

A

Doxorubincin and Trabectedin. Second line options-Gemcitabine and dacarbazine. Gemcitabine and vinorelbine. Trabectidin alone can be used if it wasn’t used first line.

28
Q

What is the second line treatment for recurrent/metastatic endometrial cancer that is progressed on platinum therapy and lacks MSI-H and is MMR proficient?

A

Pembro and Lenvatinib

29
Q

In advanced/metastatic endometrial cancer that progresses on platinum therapy what are the tx options for TMB high tumors? MSI-H/dMMR tumors?

A

TMB-H: Pembro
MSI-H/dMMR: Pembro or Dostarlimab

30
Q

What are third line options for advanced/metastatic endometrial cancer? What options can you use specifically for carcinosarcoma?

A

They mention cisplatin regimens, but in a person with platinum resistance this won’t work. Doxorubicin, lipo doxorubicin, topetecan, Bevacizumab, Cabozantinib. Ifosfamide/Paclitaxel (carcinosarcoma), Cisplatin/Ifosfamide (carcinosarcoma)

31
Q

In advanced/metastatic endometrial cancer that is dMMR/MSI-H what options do you have in the third line setting?HER2? NTRK?

A

Pembro, Dostarlimab, Avelumab, Nivolumab. Her 2 2+/3+-Trastuzumab Deruxtecan NTRK-larotrectinib or entrecrinib